Injecting drug use IDU

GENEVA, 26 June 2024—UNAIDS welcomes the recent report by Dr Tlaleng Mofokeng, Special Rapporteur on the Highest Attainable Standard of Physical and Mental Health, which was presented to the 56^th session of the UN Human Rights Council. The report, on Drug Use, Harm Reduction and the Right to Health, demonstrates the public health necessity of moving away from punitive approaches to people who use drugs.

Notable, in particular, are three recommendations of the Special Rapporteur’s report that are critical to ending AIDS as a public health threat:

1. Decriminalization of the possession of drugs for personal use.
2. Ensuring the availability, accessibility, acceptability and quality of harm reduction services for people who use drugs.
3. Ensuring that peer-led initiatives have the necessary political and policy support and sufficient and stable resourcing.

Currently, many people who inject drugs continue to be left behind by the global HIV response. The risk of acquiring HIV is 14 times higher than it is for the adult population generally. In contrast, countries which have successfully scaled up harm reduction services have seen significant declines in HIV infections among people who use drugs.

Harm reduction services need to be accessible and acceptable to all who use them. Currently, whilst women who use drugs have a higher prevalence of HIV than men who use drugs, harm reduction services are still often not designed with women’s particular requirements in mind. As the Special Rapporteur on the Right to Health’s report recommends to states: “Design harm reduction services so that they provide suitable environments for women who use drugs, including by providing integrated sexual and reproductive health care, information and services, and childcare”.

Law reform is essential because the evidence shows that even when services are available and appropriate, punitive laws obstruct their use. Criminalization of drug use is associated with needle sharing and avoidance of harm reduction programmes, and increased risk of HIV.

Community leadership in programme design is vital for programme effectiveness. As UNAIDS Executive Director Winnie Byanyima noted today at the special side event with Dr Tlaleng Mofokeng: “Barriers to accessing services can only be overcome if the communities living with, affected by and vulnerable to HIV are supported to lead. This includes communities of people who use drugs, sex workers, gay men and other men who have sex with men, transgender people and people living with HIV. We will continue to leave people behind if we do not support communities in the lead in both service delivery and law reform.”

Global and national approaches to drug policies are starting to change, and this excellent report by the UN Special Rapporteur on the Right to Health will help accelerate this small but important and growing wave of changes. As this report notes, the FRESH project, for example, is engaging transgender women in harm reduction programming, with UNAIDS support. Kenya is one of the countries which has scaled up services, and currently has more than 10 public opioid agonist therapy programmes and 35 drop-in centres with needle-syringe programmes, as well as take-home naloxone, pre-exposure prophylaxis and HIV self-testing services. This year, the Commission on Narcotic Drugs adopted, for the first time, a resolution recognizing the need for harm reduction.

Punitive approaches have hurt public health, including the HIV response. Evidence-based approaches will help enable the world to end AIDS as a public health threat by 2030. UNAIDS pays tribute to Dr Tlaleng Mofokeng, and stands with communities as they issue a call to leaders worldwide: “Support, don’t punish”.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

VIENNA/GENEVA, 22 March 2024— UNAIDS welcomes the adoption of a key resolution today at the 67th session of the United Nations Commission on Narcotic Drugs (CND), recognizing harm reduction for the first time as an important part of an effective public health response. The resolution encourages member states to develop and implement harm reduction measures to minimize the adverse public health and social consequences of the non-medical use of illicit drugs. UNAIDS congratulates the CND and the CND Chair for this historic milestone.

The resolution represents a landmark in political commitment to a rebalancing of drug policy towards a public health approach. Such a shift is critical to meeting the targets in the 2021-2026 Global AIDS Strategy.

Harm reduction is a “a comprehensive package of evidence-based interventions, based on public health and human rights, including needle syringe programmes (NSPs), opioid agonist maintenance therapy (OAMT) and naloxone for overdose management. Harm reduction also refers to policies and strategies that aim to prevent major public and individual health harms, including HIV, viral hepatitis and overdose, without necessarily stopping drug use.” (World Health Organization, 2022).

Since 2018 only five countries have reported achieving the target of providing 200 sterile needles and syringes per person who inject drugs. In that same timeframe only three countries reported achieving the target of 50% coverage of opioid agonist maintenance therapy among people who inject drugs.

The criminalization of drug use and possession for personal use in at least 145 countries, along with stigma, discrimination and violence, continues to restrict both the provision of and access to life-saving harm reduction services.

A failure to invest in harm reduction services or remove the structures that inhibit access, including those relating to gender, have led to a situation where HIV prevalence among people who inject drugs is 7 times that of the rest of the population, and people who inject drugs have the highest incidence globally of any key or vulnerable population. In countries with data, median HIV prevalence among women who inject drugs is almost twice that of men who use drugs.

Under the UN Common Position on Drugs, UNAIDS collaborates with other UN agencies and partners with governments, community-led organizations and donors to increase the provision of harm reduction services and remove harmful laws and policies which create barriers to accessing such services, such as the criminalization of possession of drugs for personal use. UNAIDS works to ensure all efforts relating to drug policy are in conformity with international human rights, as outlined in the international guidelines on human rights and drug policy.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

VIENNA/GENEVA,14 March 2024—At the 67th meeting of the United Nations Commission on Narcotic Drugs taking place in Vienna, UNAIDS has called for the urgent scaling up of services to prevent new HIV and viral hepatitis infections among people who use drugs. Addressing delegates in her video message, UNAIDS Executive Director, Winnie Byanyima, commended some countries for making progress in implementing evidence-based programmes but called for bolder action.

“Gathered here are leaders whose decisions can save and transform lives, tackle social exclusion, and protect public health for everyone. As leaders you can deliver on the shared pledge to end AIDS as a public health threat by 2030 – if all people can secure the HIV prevention, testing, treatment and care services they need. To end AIDS we need to ensure that no one is excluded,” said Ms Byanyima.

Since the 2019 Ministerial Declaration of the United Nations Commission on Narcotic Drugs (CND) there has been some progress in a rebalancing of drug policy towards public health. Several countries have moved towards a more public health-based approach to drug use, with some, such as Ghana, decriminalizing all personal drug use. UNAIDS is supporting Brazil in engaging transgender women in harm reduction programming.

The context of the COVID-19 response led some countries to increase the availability of take-home doses of opioid agonist maintenance therapy, such as in Vietnam. Communities have been central to progress in programmes and policy reforms; in Kenya, Tanzania and Uganda peer groups have been instrumental in delivering harm reduction interventions, law enforcement training sessions and awareness-raising initiatives, including women-centred harm reduction services in Kenya.

But progress remains piecemeal. Services such as needle-syringe programmes, and opioid agonist maintenance therapy, crucial for reducing HIV and other health risks among people who inject drugs, only exist in around 50% of countries. In 2019, UNAIDS reported that only 1% of people who inject drugs had access to recommended harm reduction services, and since then no additional country has reported achieving recommended levels of coverage.

Too often, laws and policies continue to exacerbate exclusion, and people who use drugs are today seven times more likely to be living with HIV than other adults. Drug possession for personal use is still criminalized in 145 countries – with 34 countries retaining the death penalty. The stigma, and outright fear, that this exacerbates is driving people away from vital health services.

Attending the meeting in Vienna, UNAIDS Deputy Executive Director, Christine Stegling said:

“We know that drug prohibition has failed. Punitive drug laws and law enforcement practices create significant barriers for people who inject drugs to access a range of services, increasing their risk of acquiring HIV and reducing their access to services. To protect public health, we need to decriminalize possession of drugs for personal use, we need to significantly scale up harm reduction service provision, and we need to make sure that communities of people who use drugs are adequately resourced and in the lead in the response.” 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

A new report by UNAIDS demonstrates the critical role communities play, and how underfunding and harmful barriers are holding back their lifesaving work and obstructing the end of AIDS.

LONDON/GENEVA, 28 November 2023—As World AIDS Day (1 December) approaches, UNAIDS is urging governments across the world to unleash the power of grassroots communities across the world to lead the fight to end AIDS. A new report launched today by UNAIDS, Let Communities Lead, shows that AIDS can be ended as a public health threat by 2030, but only if communities on the frontlines get the full support they need from governments and donors.

“Communities across the world have shown that they are ready, willing and able to lead the way. But they need the barriers obstructing their work to be pulled down, and they need to be properly resourced,” said Winnie Byanyima, Executive Director of UNAIDS. “Too often, communities are treated by decision-makers as problems to be managed, instead of being recognised and supported as leaders. Communities are not in the way, they light the way to the end of AIDS.”

The report, launched in London during a World AIDS Day event organized by the civil society organization STOPAIDS, shows how communities have been the driving force for progress.

Community advocacy from the streets to the courtrooms to parliaments has secured groundbreaking changes in policy. Communities’ campaigning helped open up access to generic HIV medicines, leading to sharp, sustained reductions in the cost of treatment from US$ 25 000 per person per year in 1995 to less than US$ 70 in many countries most affected by HIV today.

Let Communities Lead shows that investing in community-led HIV programmes delivers transformational benefits. It sets out how programmes delivered by community-based organizations in Nigeria were associated with a 64% increase in access to HIV treatment, a doubling of the likelihood of HIV prevention service utilization, and a four-fold increase in consistent condom use among people at risk of HIV. It also notes how, among sex workers reached by a package of peer-based services in the United Republic of Tanzania, the HIV incidence rate was reduced to below half (5% vs 10.4%).

“We are the vehicle for change that can end systematic injustices that continue to fuel HIV transmission. We have seen groundbreaking developments with U=U, improved access to medicines, and have made great strides in decriminalisation," said Robbie Lawlor, Co-Founder of Access to Medicines Ireland. “Yet, we are expected to move mountains without being financially supported. We are supposed to fight for a more equitable world and are tasked with dismantling stigma yet are side-lined in crucial discussions. We are at a tipping point. Communities can no longer be relegated to the periphery. The time for leadership is now.”

The report highlights how communities are at the forefront of innovation. In Windhoek, Namibia, a self-funded project by the youth Empowerment Group is using e-bikes to deliver HIV medicines, food and adherence support to young people who often cannot attend clinics due to their schooling hours. In China, community organizations developed smartphone apps that link people to self-testing which contributed to a more than four-fold increase in HIV tests across the country from 2009 to 2020.

The report reveals how communities are also holding service providers to account. In South Africa five community networks of people living with HIV inspected 400 sites across 29 districts and conducted more than 33 000 interviews with people living with HIV. In the Free State province, these findings led provincial health officials to implement new appointment protocols to reduce clinic wait times and three- and six-month dispensing of antiretroviral medicines.

“I am extremely concerned about the exclusion from health services of key populations like the LGBT+ community,” said Andrew Mitchell, Minister of State for Development and Africa. “The UK champions the rights of such communities, and we will continue to protect them, working closely with our partners in civil society. I thank UNAIDS for keeping us focused on the inequities driving the pandemic and I look forward to working with our partners to champion the voice of people living with HIV and end AIDS as a public health threat by 2030.”

Despite the clear evidence of community-led impact, community-led responses are unrecognized, under-resourced and in some places even under attack. Crackdowns on civil society and on the human rights of marginalized communities are obstructing communities from providing HIV prevention and treatment services. Underfunding of community-led initiatives is leaving them struggling to continue operating and holding them back from expansion. If these obstacles are removed, community-led organizations can add even greater impetus to end AIDS.

In the 2021 Political Declaration on ending AIDS, United Nations member states recognized the critical role communities play in HIV service delivery, particularly to people most at risk of HIV. However, whereas in 2012, when over 31% of HIV funding was channelled through civil society organizations, ten years later, in 2021, only 20% of funding for HIV was available—an unprecedented backsliding in commitments which has cost and is continuing to cost lives.

“At this time, community-led action is the most important countermeasure in the AIDS response,” said Solange Baptiste, Executive Director of the International Treatment Preparedness Coalition. “Yet, shockingly, it isn’t a cornerstone of global plans, agendas, strategies, or financing mechanisms for improving pandemic preparedness and health for all. It is time to change that.”

Every minute, a life is lost to AIDS. Every week, 4000 girls and young women become infected with HIV, and out of the 39 million people living with HIV, 9.2 million do not have access to lifesaving treatment. There is a Path that Ends AIDS and AIDS can be ended by 2030, but only if communities lead.

UNAIDS is calling for: Communities’ leadership roles to be made core in all HIV plans and programmes; Communities’ leadership roles to be fully and reliably funded; And for barriers to communities’ leadership roles to be removed.

The report features nine guest essays from community leaders, in which they share their experience on the achievements they have secured, the barriers they face, and what the world needs to end AIDS as a public health threat.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.